Cruise Ship Journeys: Expect the Unexpected

"Although uncommon, limited human‑to‑human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact."

"Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare."

WHO situation report

 

"[Everyone on board is] in the same boat, literally."

"You don’t embark on a trip with the idea that one of your fellow passengers won’t make it."

"We receive information at regular intervals. It is accurate. For the rest, it is a waiting game."

"Today we received fresh fruit and fresh vegetables. That was very important to us."

Helene Goessaert, ship passenger

 

"We do know that some of the cases had very close contact with each other and certainly human-to-human transmission can’t be ruled out so as a precaution this is what we are assuming."

"The risk to the general public is low, [any suspected human-to-human transmission would have occurred between very close contacts like married couples]."

"This is not a virus that spreads like flu or like COVID. It’s quite different."

Dr. Maria Van Kerkhove, WHO director for epidemic and pandemic preparedness and prevention  

WHO: Human-to-human transmission may have occurred aboard the Hondius expedition ship. Still from video, CBCNews

 

According to the Wold Health Organization, commenting on a viral outbreak aboard a cruise ship in the Atlantic Ocean, thus far one case of hantavirus has been confirmed, with five suspected cases. Two of those cases were fatal; within a three-week cruising period, three of the ship's passengers have died. Many such cruise ships carry far more passengers than the Hondius expedition ship; thousands in comparison to hundreds. So with that relatively small number of passengers, that three have mysteriously died represents quite a shock.

 

According to the operator of the Hondius -- Oceanwide Expeditions -- one ship's passenger is in intensive care in Johannesburg and two crew members remaining aboard the vessel exhibit respiratory symptoms. The ship is now carrying 87 passengers and  61 crew. Typically, following exposure to the virus, symptoms begin to erupt between one and eight weeks. The remaining passengers may or may not begin to exhibit further signs of the viral infection.

 

Hantavirus is an extremely serious condition normally linked to exposure to the urine or feces of infected rodents. It is able, in rare instances, to spread in people-to-people contact. Hantaviruses are capable of causing serious illness and death, spread for the most part by rodents. That infection can be the cause of hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome, common respectively in the United States and Europe and Asia. What they have in common, whatever the symptoms in the family of the virus, is their severity and potential lethality. 

 

The cruise ship MV Hondius is seen stationary off the port of Praia, the capital of Cape Verde, on Monday. (AFP/Getty Images)

 

The condition in which the remaining passengers and crew on board the ship is one of uncertainty. They await permission to leave the ship at some port whose national health authority may permit them to disembark and regain their position on land. And from there, they can arrange to be repatriated to their countries of origin. But this cannot be done without thorough medical examinations and testing for the presence of the virus, since they may be regarded as ticking health time-bombs. Any who do begin to exhibit symptoms may speedily deteriorate into life-threatening condition. 

 

On Monday, Oceanwide Expeditions released a timeline of the "serious medical situation" aboard the Hondius off the coast of Cape Verde, along the western coast of Africa. A Dutch passenger died on board on April 11, cause of death unknown at the time. When the dead man was brought off the ship, his wife accompanied him. Once she too had left the ship, she too became ill and subsequently died, just as her husband had.

 

Two weeks later, a British passenger became seriously ill and was medically evacuated to South Africa and there, hantavirus was identified. He remains in the intensive-care unit of the  hospital he was placed in, in stable but still critical condition. And then a third passenger died on Saturday, a German national. It remains unconfirmed at this point whether all three deaths were caused by hantavirus.   

"Hantaviruses are a group of rodent-borne viruses typically transmitted through contact with contaminated environments, including inhalation of small dust particles contaminated with rodent urine, droppings, or saliva."

"Although human infections are uncommon, they can lead to severe illness, including hantavirus pulmonary syndrome (HPS), which may progress rapidly to respiratory failure."

"In the Americas, HPS has a reported case fatality rate of approximately 30 to 40 percent, underscoring the seriousness of infection once symptomatic, according to the Centers for Disease Control and Prevention."

"Unlike respiratory viruses such as influenza or COVID-19, hantaviruses are not typically spread from person-to-person, however direct human transmission has been documented for one hantavirus, the Andes virus, under conditions of prolonged, close contact. The Andes virus is endemic to Argentina, where the cruise ship departed three weeks ago."

News Medical Life Sciences 

 

Steerage Class : COVID Ghost Ship

The Diamond Princess has become subject of several studies. Credit: Princess Owned (NAM).

"We felt like only the rich would be taken care of."

"It's not only the passengers who are threatened by this virus, so why are we still working?"

"We were afraid we would never see our families again."

Maruja Daya, pastry chef

"As you can see, ladies and gentlemen, the situation is under control and therefore there are no reasons for concern."

Ship's Captain

"We couldn't just stay in our rooms."

"We delivered 3,000 meals, three meals a day, to all the guests."

Luke Hefner, ship entertainer

 

"It was impossible to attend to every single person. We were basically just surviving, because it was really non-stop from morning to night."

"It's such a confined space that it's impossible for them [ship's crew] not to have exposure to each other."

"They didn't know that they [asymptomatic crew members] were spreading it [novel coronavirus]."

Franco Swart, crew doctor

 

"It became really difficult for me because we were not even allowed to step out of the cabin."

"On the crew decks, there are no windows, no ways that you can look outside. You don't know what time of the day it is until you look at the clock."

Sonali Thakkar, security worker, Diamond Princess cruise ship

Emergency workers in protective gear exit the Diamond Princess on February 10. As the ship was parked at the port, supplies were brought in and sick passengers taken away to isolation on shore.   Photograph: Carl Court/Getty Images

A new HBO documentary titled The Last Cruise follows the course of events that overtook crew and passengers on the Diamond Princess cruise ship docked in Tokyo Bay early last year as the coronavirus paralyzed the population on board the ship, spreading in an environment conducive to infectiousness. Where the crew were much more vulnerable to the SARS-CoV-2 pathogen than the passengers, protected through isolation, despite which passengers too became infected with the virus.

 

Several passengers and crew members were followed as an exhibition/illustration of how each experienced an unexpected, insidious entry of a threatening virus, completely changing the nature of the enterprise they had set out upon early in the new year of 2020. Leaving port on January 20, 2020 the casino was filled with happy passengers looking forward to a fascinating, interesting and entertaining voyage. It was only interesting viewed in the sense of that old Chinese curse: "may you live in interesting times".

Group activities were full of enthusiastic passengers taking part, wandering freely about the ship; a holiday environment. And then came an announcement on February 3, with the captain alerting passengers that one passenger from Hong Kong aboard for five days, had tested positive for COVID-19. Irrespective of the captain's assurance that there was no cause for concern, ten more people tested positive two days on, and passengers were informed of room quarantines for a period of 14 days.

That wasn't the end of the story; isolation, control, and all is well. COVID numbers kept rising until a total of 712 people were finally confirmed with the virus, among whom 14 individuals died of its effects. While crew members worked to protect passengers, they were themselves vulnerable to the contagion, all the more so in their cramped common areas, sharing living quarters with shipmates who were falling ill.

Eight public servants who visited the Diamond Princess to support a quarantine contracted the virus that causes COVID-19. Kyodo/Newscom

Of the 1,045 crew who were diagnosed with COVID, fully a third were asymptomatic. Soon, the ship became the site of the largest coronavirus outbreak outside China, a living laboratory to study transmission and outcomes among the 2,666 guests and 1,045 crew serving their best interests. The conditions in which crew members worked in kitchens and cramped hallways as they cleaned elevators and they gathered to pray added to their contagion-vulnerability.

Passengers were eventually removed from the ship so that those who had managed not to contract COVID could return to their home countries after a quarantine period, while those who were ill with COVID were hospitalized in Yokahama and carefully attended until recovery. Among crew members, on the other hand, many remained aboard.

"I really want to breathe the fresh air outside. After all the passengers were sent home, it was then that we became scared for our lives, said Dede Samsul Fuad. Yet he also commented: "Not everyone can have the opportunity to work on a cruise ship, and I hope I will again soon", an Indonesian who worked as a dishwasher aboard the ship. He and other crew members had made a public plea to be evacuated before they became ill with the virus. Indonesian crew members were the last to be evacuated on March 1.

Photograph: Philip Fong/Getty Images